ICU Laughter
Tears rolled down our faces as we laughed . It is uncommon to hear laughter in the surgical intensive care unit ( SICU ). It would have startled me , if I weren ’ t the one laughing . The ICU is full of beeping machines , hushed tones and the huff and puff of the ventilator .
The sounds create a frantic cacophony , which instills some fear and anxiety . We would slide the doors to the workroom closed , and it would feel like a deep breath . The only sounds would become the typing of residents and occasional conversations . Even though the doors were glass , it felt like a little oasis away from the noise and bustle of the SICU , especially for a medical student .
My patient ’ s room was diagonal to the work room . I could look up from my computer and see into the room . I liked checking on her . She was my first patient in the SICU . Patients and families came and went , but she stayed . She was admitted on my first 24-hour call in the SICU after a single car highway high-speed MVA with multiple traumas . She was complicated from the start . At first , she seemed like any other middle-aged trauma patient , but slowly , her story started to unfold . She had idiopathic cirrhosis that was severe . Even sedated , she interacted with us . She would squeeze my hand in the morning , and she loved being around her family even though she couldn ’ t really speak through the sedation , nasal intubation and wiring of her jaw .
Family was huge to this patient . Her family were farmers , so her husband would call us on his way to feed the animals at 5:00 a . m . then he would come in , to stay with her during the day . This became routine . I was used to picking up the phone like clockwork when he called in the mornings . He always knocked on our workroom ’ s glass door to wave at us when he got there too . Her daughter was a farmer ’ s wife and nurse aide . She usually came at night with her arms full of cards her kids drew for their grandma . Her daughter didn ’ t want the kids to see their grandma this bruised and battered from the accident , so they didn ’ t come . They always drew more pictures and cards . Soon , the plain walls of the room were full of colorful drawings and pictures .
Over the days , the patient got better and worse . She would seem to turn a corner , but mostly , she stayed the same . It was the limbo of waiting in the SICU . Everyday , I would go sit with her family and talk , usually once with her husband and once with her daughter . I would catch them up on the day ’ s events , and we would talk about
28 LOUISVILLE MEDICINE by ALYSSA BROWN , MD
anything and everything . While there was often nothing really to report , they found solace in talking . I got to hear stories about her , which brought her to life . She loved horses , and she had ridden them for years . I got to see pictures of their farm and of the family .
Her daughter knew I had been struggling that month in the SICU . She could tell that the deaths were wearing on me . While we didn ’ t talk about other patients , we just talked . One night during my last week , she blurted out , “ My mom is going to kill me if I don ’ t pluck that chin hair .” I followed it up with , “ My mom wants to be cremated because she doesn ’ t think anyone can do her hair right .” We couldn ’ t help it . We both laughed until tears sprang up in our eyes . That memory will stick with me . It was the first time I had laughed in the SICU in a long time . It was a release . They reminded me of my own family .
As the last week of the month ended , she started to get worse . First her liver , then her kidneys started to shut down . One of the residents reminded me that we had been working on borrowed time from the start . She did not have good chances from the moment of the accident , but we had staved off death for a few weeks . I had gotten my hopes up . Over the last few days of my rotation , I started to tell them that I would no longer be visiting with them every day . Another student would be seeing them . It was sad . They had been a bright spot on many of my days . They had been the consistency in the chaos . The last day , we said our goodbyes , and I promised to check on her .
I texted the student who replaced me after his first day and asked how she was doing . He just responded , “ She ’ s dead .” He left it at that . I knew this time would come , but it did not make it easier . The tears still rolled down my cheeks .
As I have gone through medical school , I have seen many patients die . They have affected me . I try to make time to mourn them . I looked up her obituary , and I got to see pictures of her life — the grandkids , family , farm and pictures of her before the SICU . I kept thinking about her family and the laughter they provided me during my time . We are in a symbiotic relationship in the hospital . I provided them support and a friendly face in the SICU , and they provided me a respite and laughter . I cannot thank them enough for this . I will never forget them .
Dr . Brown is a PGY-1 general surgery resident at Northwestern University and a former University of Louisville School of Medicine student .
This essay was a submission to the 2022 Richard Spear , MD , Memorial Essay Contest .